Quantitative Coronary Plaque Analysis in Clinical Practice: 2025 ACC Scientific Statement

Comprehensive Summary

In this 2025 ACC Scientific Statement, Chandrashekhar et al. outline when and how quantitative coronary plaque analysis (QCPA) from coronary CT angiography should realistically be utilized in clinical practice. The statement discusses growing interest in AI-enabled plaque quantification, while emphasizing that evidence for improved patient outcomes remains limited. Though quantitative measures, especially total and noncalcified plaque volume, correlate well with invasive imaging and show prognostic value, the committee highlights major hurdles, including vendor variability, lack of standardized thresholds, and uncertainty around the clinical meaning of small or subvisual plaque detected only by AI. Consequently, the statement restricts recommended use of QCPA to patients with visually apparent plaque on CTA and emphasizes the need for physician oversight when interpreting automated outputs.

Outcomes and Implications

QCPA is best viewed as a complementary tool for refining cardiovascular risk assessment rather than a complete replacement for visual CTA interpretation or established risk frameworks. In selected patients with known plaque, quantitative metrics may help guide the intensity of preventative therapy. However, routine serial QCPA is not advisable, given unresolved questions about reproducibility, meaningful thresholds of plaque progression, and cost-effectiveness. Wider adoption will depend primarily on standardization, prospective validation, and more conclusive evidence that QCPA meaningfully changes management or outcomes.